I graduated from veterinary school in 1972.  The world was different then.  The Vietnam war was in full swing, President Nixon was getting ready to run for a second term, Neil Armstrong had recently walked on the moon, and a new car could be purchased for under $2000.  Gasoline was 30 cents per gallon.  A young WSU radiologist, Dr. Norman Rantanen was working on sonar technology borrowed from the navy and was trying to figure out how to use sound waves as a diagnostic imaging modality.  He and other pioneers in the field were successful, and now most veterinary practices and all human hospitals have diagnostic ultrasound machines.  Dr. Barry Grant, an equine surgical resident showed me a  calculator that he had bought for about $300 that would add, subtract, multiply, and divide; it would fit in the palm of your hand.   Calculators in those days were called adding machines; they weighed 10 to 20 pounds, and were as big as a typewriter, another common fixture on every desk.  The administration building at WSU had a large room that housed a computer to keep track of student records; it cost hundreds of thousands of dollars and had a fraction of the computing power of my cell phone.  Needless to say, the internet was years in the future.
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          Veterinary students were different then also.  In my class of 50 students, 45 of us were male and most of us came from farms and ranches.  Most of us went to veterinary school to learn how to take care of livestock and the occasional pet, and our dream was to go back to the small towns and ranches from which we came.   Of the 5 women in my class 3 entered primarily large animal practice, one went into mixed practice, and only one went into small animal practice.  We were expected to wear white or pastel shirts and neckties to class, which most of us did. 
I did ranch work and trained horses during the summers, cleaned kennels at 6 AM every day at the Veterinary School during the school year, and worked weekends for a local Whitman County farmer to help pay my way through college.  Wages for students at that time was about one dollar per hour.  Tuition at WSU was $172.50 per semester, and Veterinary students paid another $100 to pay for lab supplies.  I came out of school with a whopping $5,000 student loan debt.  Starting wages for a new Veterinary graduate going into rural practice was in the neighborhood of $1000 to $1200 per month.  I ended up going into the US Army as a Captain in the Army Veterinary Corps at a salary of about $900/month; it looked like a fortune to me at the time!

           At WSU today (and WSU is typical of the other veterinary colleges across the country) more than 80% of the Veterinary students are female and the majority come from urban areas.  Veterinary students with a farm background are rare, and many of those who do come from rural areas choose to go into urban practice following graduation.  Most students graduate with student loan debts in excess of $100,000, and loan debts in excess of a quarter of a million dollars are not uncommon.​

          This is creating a crisis in rural communities as it is becoming increasingly more difficult to recruit new Veterinary graduates to rural areas where the nation's livestock is produced.  Many new graduates actually want to do both large and small animal practice, however not many have the background to successfully work on farm animals and soon lose their desire to do so.  Many new graduates who wish to settle in rural areas are forced to go into high end urban practices that can afford to pay them the huge salaries they need to service their college loan debts. 

          Rural America, particularly in the West, is full of small communities with closed veterinary clinics or clinics with an older veterinarian unable to find a young associate willing to move there and take over his practice.  In our local area, Pomeroy and Dayton in Washington; and Grangeville, Orofino, and Kamiah in Idaho have either lost their local veterinarian or have veterinarians wanting to retire and nobody to take over their practice. 
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          We are fortunate here that we are in close proximity to a Veterinary College at WSU, and as a preceptor practice we assist in training of senior Veterinary students; consequently we have had some success at recruiting associates through our contacts there.  We have also been able to find quality people from out of the area who find this community an attractive place in which to live.  Even though we are somewhat rural we are in close proximity to a reasonably large city (Spokane), we have access to some of the most spectacular outdoor activities in the country, and we are in close proximity to four great educational institutions (LCSC, UI, WSU, and WWCC).   In addition we have some of the most wonderful clients in the world which makes it much easier to recruit quality people!
          The Covid Viral pandemic has created a whole new bunch of challenges not only for us, but for most every business and household in the country (and world).  Our Veterinarians and staff appreciate your patience in helping us work through this crisis, we appreciate all of you!

                                                By David A. Rustebakke, DVM
 
            Veterinary Medicine and Animal Nutrition are separate specialties in the animal care industry; however in my career I have found that in order to give good health care advice I need to know something about nutrition. As primary care health providers to these animals, the veterinarian is the one who actually has eyes on the animal or on the herd, and we are in the best position to diagnose a nutritional problem and recommend  specific products to help solve a problem. 
 
Nutritional based diseases seen in a typical veterinary practice
 
            Malnutrition or under nutrition is by far the most common problem I see.  This is often a result of ignorance (as opposed to willful neglect) on the part of the owner.  These animals are often presented to look for a reason for weight loss.  Most of have dental problems, which we correct as well as possible.  However the dental problems are often not severe enough to be the entire reason for the weight loss.  To fully work up these horses we do a thorough physical examination including taking the vital signs (temperature, pulse, and respiration, listening to the heart and lungs, assessing body condition, hydration, capillary refill time, look for chronic pain issues, see if the stated age corresponds with the age estimated by the teeth, etc..).   If no obvious problems are noted, we recommend a blood test (serum chemistry and CBC) to look for any chronic infections or organ system failure.  If we identify a specific disease condition, the recommendations are based on whatever disease we see.  Otherwise, the next step is to assess the diet and recommend changes.
 
            From here, this is not rocket science.  We know that a horse requires a certain number of calories per day for maintenance, and a few more calories for work or production.  This can vary from 15 Mcal per day for an average sized horse at maintenance to over 30 Mcal per day for a horse working hard, or in maximum lactation.  The problem with most of these horses is not a lack of vitamins or minerals or other micronutrients or probiotics; the problem is a shortage of calories.  They may be lacking vitamins, minerals, etc. but that is not why they are thin; they are thin because they are not getting enough to eat.  They may or may not be getting enough pounds of feed (2% of body weight per day is the common recommendation).  But many of the forages do not have the energy density to provide the required caloric intake at the 2% level.  So the solution is to increase the energy density.  That is when I refer them to the feed store to provide them with products that will increase the energy density without causing secondary problems.  There are a myriad of products out there designed to do just that.  It is important to use a product that is safe, which means combining soluble carbohydrates such as found in grain products, with digestible fiber and fat.  Most of the commercial products out there, if fed as per the manufacturer's label instructions, also include the required vitamins and minerals and often other products to make the entire diet more digestible as well. 
 
            Over nutrition and obesity is the next most common problem that I see in practice.  This is also often due to a misguided sense of what is good for the horse.  A few of these in my practice area are due to the breed standards required by halter classes in horse shows.  There is nothing I can do to solve the obesity required by the AQHA halter horses, but I can make dietary recommendations on obese horses, and it is up to the owner to either take or reject my advice.
           
            We used to think that obesity in horses was not a significant health issue.  Horses do not get coronary artery disease as do people, so from that standpoint it is not a big deal.  However, over my practice career I have become convinced that it is a huge issue affecting the long term quality of life as well as longevity.  Overweight horses like overweight people put more stress on their joints, and are much more susceptible to lameness problems especially as they get older.  Laminitis or founder is a multi factorial disease, but regardless of the inciting cause it is much more difficult to manage in overweight animals due to the increased pressures involved because of the excess weight.  When I see a grossly obese horse, I explain to the owner the risks associated with obesity, and often refer them a feed store to provide products to deal with it.  My recommendation is to reduce the quantity of feed (I usually start out recommending they feed half of what they are presently feeding) of a mediocre quality grass hay, and balance that with an appropriate protein, vitamin, and mineral supplement.  What we want to do is reduce the total caloric intake while maintaining an adequate intake of protein, vitamins, and minerals.
 
            Laminitis or Founder is another frequently seen problem in equine practice.  Although this is a very complex disease with a myriad of causes, nutrition has a huge role in its cause and in its treatment. 
            Without getting over technical, this is a disease that is generally caused by ingesting a high carbohydrate meal. In horses the disease results from carbohydrates being fed at a rate that allows them to pass into the fermentation vat (large colon and cecum).  The sugars and carbohydrates are supposed to be broken down and absorbed out of the stomach and small intestine prior to entering the large colon; large amounts of sugars in the large intestine results in the organisms living there having a massive overgrowth.  The overgrowth of gram negative bacteria in either the rumen of ruminant animals or the large colon of horses results in an increase of bacterial byproducts and an increased acidity.  This causes large scale death of the bacteria, resulting in decomposition of the bacterial cell wall, and the release of a product known as endotoxin; a component of the bacterial cell wall.  The endotoxin causes many adverse events; primarily it increases the permeability of the cell walls of the capillaries in the hoof.  This results in swelling of the soft tissues of the hoof.  The soft tissues of the foot are encased in a rigid structure known as the hoof capsule that is a perfectly fitting but tight boot.  When swelling occurs inside something that can’t accommodate swelling, you get increased pressure.  When the pressure gets near to or exceeds the blood pressure the blood flow diminishes inside the hoof, resulting in weakness or death of tissues inside the hoof.  In an extreme case the hoof will actually fall off.  Milder cases may recover completely, or have varying degrees of chronic lameness depending on the amount of damage and whether or not the damage is irreversible.
            The first sign of laminitis is usually reluctance to move.  When they do walk, they have a stilted gait.  When this is seen it is important to get a veterinarian on your team to help manage the problem.  The first step is to get a diagnosis; this is done through history, clinical examination, observation of the typical laminitic gait, the presence of heat and inflammation in the feet, and possibly other systemic signs related to carbohydrate overload.  Treatment is aimed at mechanical support of the structures in the hoof, and reduction of the inflammation by the judicious use of drugs, such as non steroidal anti inflammatory drugs, and ice water baths. 
            Many of these horses are susceptible to recurring attacks of laminitis even if they recover completely.  Nutritional management becomes an important part of their care for the rest of their life. 
 
            Nutritional management consists of providing a diet that provides them with all of their basic nutritional requirements while minimizing the amount of soluble carbohydrates.  The portion of the diet that provides energy should be low in soluble carbohydrates; the energy is made up by providing higher than normal amounts of digestible fiber, and fat
 
Equine Exertional Rhabdomyolysis is another fairly common disease seen that has a nutritional component in treatment and prevention.  When I attended veterinary school in the 1970’s it had several names, Monday Morning Disease, Azotemia, Myoglobinuria, Tying Up Syndrome, among others.  It was typically seen in heavy muscled horses that were on a high plane of nutrition, and the treatment at the time was anti inflammatory medication, muscle relaxants, rest, fluid therapy, and decreasing the grain and concentrates in the ration.  Forty years later, we have a new name for it, and a much better understanding of what causes it and why, but the treatment has not changed much.  We now know that many of these horses have a genetic predisposition for this, and we have learned how to identify these horses through genetic testing, which until recently wasn’t an option.  What happens is that these horses have the ability to store large amounts of the polysaccharide “glycogen” in their muscle tissue, which when it breaks down during exercise produces metabolites that can injure the muscle causing it to release the muscle pigment myoglobin into the blood stream.  It turns out that the myoglobin is toxic to the kidney, so in a severe case this can cause kidney failure.  When a horse has an acute case, it generally requires aggressive veterinary treatment with the aforementioned therapies to have a successful recovery.  The important thing is to manage at risk horses nutritionally so that acute episodes do not occur.  That is where feed manufacturers come in; there are many commercial feeds on the market today specifically designed to prevent episodes; they all involve feeding high digestible fiber rations with low soluble carbohydrates; animals at work requiring high energy diets get the majority of their calories from fat and digestible fiber rather than sugar and starch.  For those of you interested, a detailed paper is available on the AAEP Website at the following address:   http://www.aaep.org/info/horse-health?publication=782  The following is a copy of the summary of the paper By Stephanie Valberg, DVM, PhD, Associate Professor, University of Minnesota, College of Veterinary Medicine
“Exertional rhabdomyolysis (ER) has been recognized in horses for more than 100 years as a syndrome of muscle pain and cramping associated with exercise. Recently it has been recognized that this syndrome has numerous possible causes. Sporadic forms of ER are due to over-training and muscle strain, dietary deficiencies of electrolytes, vitamin E and selenium or exercise in conjunction with herpes or influenza virus infections. Chronic forms are due to specific inherited abnormalities such as polysaccharide storage myopathy (PSSM) in Quarter Horses, Warmbloods and Draft breeds or recurrent exertional rhabdomyolysis (RER) in Thoroughbreds, Standardbreds and Arabians. 
PSSM, a glycogen storage disorder, can effectively be managed by providing regular daily exercise and a high fiber diet with minimal starch and sugar and provision of a fat supplement. RER appears to be a disorder of intracellular calcium regulation that is triggered by excitement. Changing management to provide horses with a calm environment and training schedule and substitution of fat for grains in high caloric rations are helpful means to manage this condition. Exertional rhabdomyolysis continues to be a performance-limiting or career-ending disorder for many equine athletes. 
In the last 15 years, research advances have provided greater insight into this syndrome. Of greatest importance is the realization that exertional rhabdomyolysis comprises several myopathies that, despite similarities in clinical presentation, differ considerably in regards to pathogenesis (cellular events, reactions, and other pathologic mechanisms occurring in the development of disease). In addition, new knowledge regarding effective management of horses with exertional rhabdomyolysis, particularly with regard to diet, has significantly reduced the severity ER in many horses. Most recently the genetic defect for one common form of PSSM has been discovered and a DNA based test is now available.”
Developmental Orthopedic Disease is a catch all phrase for a number of bone related diseases commonly seen in young growing horses.  Developmental Orthopedic Disease (DOD is commonly seen in young fast growing horses between 3-4 months up to near 2 years old.  These young horses are presented with various degrees of lameness, or hard bony and sometimes painful swellings at the fetlocks, hocks, or knees.  The cause has been speculated to be nutritional imbalances involving Calcium, Phosphorous, Zinc, and other trace minerals; trauma, overfeeding, and various genetic factors.  I think that most of these horses have a combination of factors involved.  In fact I consider some degree of DOD to be normal in most young growing horses, and most survive it just fine.  The important thing is recognizing when it is getting out of hand, and taking steps to treat it before it causes permanent damage
 
Bone in young animals increases in length at the growth plates; there is a thin plate of cartilage at the end of the long bone that is actively laying down new bone.  The new bone is relatively soft, and is subject to damage from compressive forces during weight bearing, especially when young horses are engaged in vigorous exercise.  This trauma from exercise causes small cracks and fractures in the soft bone at the physis, and often some mushrooming out of the bone which can be seen visually.  An owner will often see this bony swelling and possibly also notice that the foal or yearling appears sore or lame.  These swellings are often sore when squeezed with finger pressure, and radiographs often show extensive bone remodeling.  This type of bone disease is known as “physitis”; commonly called “epiphysitis”.  The proper name is “physitis” as the pathology is actually in the growth plate, the physis, and not the epiphysis, which is the segment of bone between the bone end and the growth plate. 
 
Another developmental orthopedic disease is collapse of the soft bone underneath the joint cartilage of the large joints resulting in a defect in the overlying articular cartilage; a disease called osteochondritis dissicans (OCD).  Mild cases of OCD can heal with conservative treatment, but many require surgery to clean up the affected cartilage and underlying bone.  Our goal is to catch these prior to getting a serious problem, and with simple nutritional adjustments try to reverse the changes.
 
We think that the problem is that these young horses are growing faster than the bone is able to accommodate the added weight.  The next question is why are these horses growing this fast?  I think there are two answers to this question, genetics and nutrition.  The genetics was already determined at the moment of conception, we can’t do anything about the genetics at this point, so our treatment needs to address what we can control, and that is nutrition.
 
Studies have shown that the mature size of a horse is determined primarily by genetics.  However, we can make an animal grow faster sooner by increasing the energy in the ration.  A yearling that has been pushed nutritionally will be taller and heavier than a genetically similar yearling that has been on a lower but adequate plane of nutrition; however the mature height and weight will be the same.  This is of special importance in young show animals; by pushing them early we are putting them at increased risk of developmental orthopedic disease; this is true of all species, but particularly in horses because they are expected to be athletes. 
 
The first thing is to make sure the ration is as low in energy as the colt can stand, while still being reasonably balanced with the proper minerals and high quality protein.    For me as a veterinarian that generally involves my recommending the owner use a commercial feed that is already balanced.  It is also important to reduce the trauma on the damaged bone by confining the animal to a small area, and in some cases we use an anti inflammatory medication to reduce the pain so the animal is able to move reasonably normally to prevent secondary tendon problems. 
 
The final point I would like to make about nutrition is that for animals to survive and thrive, nutrition does not need to be perfect.  There is a difference between “optimum nutrition” which is what we need in production livestock and high level equine athletes, and in “adequate nutrition” which is suitable for the hobbyist or backyard horse owner. Our livestock have an amazing ability to do well on a wide variety of feed products, and even do well in the face of deficiencies of some nutrients and an excess of others.  Animals lived on whatever forages were available in nature for millions of years before we domesticated them, and the genetics that enabled them to survive then still are with them today.  As long as the deficiencies or excesses are not too severe, the internal mechanisms that control the metabolism, such as the liver and kidneys, will make the necessary adjustments.  Excess minerals and nutrients will be excreted, and deficient nutrients will be conserved to allow animals to survive and thrive even on sub optimal feeds.

​            Veterinary practice can be exhilarating, challenging, and frustrating.  I like to post pictures and descriptions of medical cases where everything turns out well.  It is fun to do, and fun to read the comments that follow.
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          In the real world not everything turns out the way we would like.  We are constantly faced with cases that have no chance for a successful resolution.  Some injuries and medical problems are irreparable.  Combine that with the fact that farm animals (and many pets) are living outside, often with an owner who has other priorities and doesn’t take the time to check them every day.  Maybe the owner is ignorant on what constitutes an emergency  (ignorance does not equal stupidity or being a bad person; we all have areas where we are not particularly knowledgeable).  Maybe the owner is knowledgeable, has done everything right, calls for professional help in a timely manner, and has the resources to take care of any problem.  And we still may be faced with a situation that has no chance for a successful outcome.  In these cases, the best I or any veterinarian can do is give our best assessment of the case, give our opinion on the chances for a successful outcome, and leave it to the owner to make the final decision.

If Zoe looks a bit sore in the above video, she has a good reason.  Four months ago she was on the verge of being euthanized from complicated laminitis.  She was in severe pain and could barely walk.

This is a story about a special horse and a dedicated horse owner.  We first met Zoe in October of 2017.  Her owner Mark Thorne had called me to evaluate her and see if there was any chance she could be saved.  She had foundered last summer, was in extreme pain, and her coffin bones had penetrated through the soles of her front feet.  She spent the majority of her time lying down.  I explained that the prognosis was grave; horses rarely survive sole penetration by the coffin bone.  Mark already knew that.  He persuaded me to drive to Harvard, Idaho and at least take a look at her.

The first chance that I got, I took a drive to Harvard.  I found  Zoe lying in a scrupulously clean stall deeply bedded in fresh shavings.  She was lying on her side to keep the weight off her painful feet; she was in good physical condition, and had no sign of bed sores.  Her feet were bandaged to keep them clean.  We removed the bandages to inspect the bottom of the feet; sure enough there were tracts in both feet that led to the tip of the coffin bones. 

We persuaded her to get up; she was so sore we had to anesthetize her front feet to get her to stand.  Radiographs (see below) confirmed that the coffin bones were rotated about 20 degrees away from the hoof wall, and the coffin bones were coming through the bottom of the feet.   Zoe had been shod with a reversed horseshoe with a lift at the back which elevated her heel and reduced the pull of her flexor tendons.  The coffin bones did not appear to be sinking, so we assumed that the laminar attachments at the heel were still intact.  But we somehow had to de rotate the coffin bone and establish a normal coffin bone angle while not increasing the pull of the tendons trying to pull the coffin bone off the anterior hoof wall.

What convinced us to try was Mark's determination to save her.  He was spending countless hours taking care of her, keeping her feet bandaged, keeping her clean, and keeping her as comfortable as possible.  Often what makes or breaks a difficult case is the aftercare.  I could see she would be in good hands by a dedicated and determined owner.

After again explaining  the poor prognosis, Mark asked us when we could start treatment.  I explained that we would need to put together a team in order to maximize our chances of saving her; we needed a veterinarian, a  veterinary technician, a competent farrier, a cooperative horse, and a dedicated owner to have any chance for success.  We had 4 out of 5; myself, my technician Sandra Whittaker,  Zoe who had  proven to be a willing participant, and Mark the owner.  We needed a farrier.

I called several  farriers that I had worked with over the years.  Paul Magan, a Certified Journeyman farrier  from Moscow lived  reasonably close and had the experience and training to help us.  I had worked with him before on other cases and knew that his skill, knowledge, and work ethic would be invaluable.  His positive, "can do" attitude was a huge asset as the treatment progressed.   

On a cold winter day, December 6, 2017, we met Paul Magan and Mark at the stable near Harvard.  Together we came up with a plan.  I would use sedation and local anesthesia to make Zoe comfortable enough to enable us to work on her.  We would use x-rays to guide how we trimmed her feet and Paul would build a shoe to give her maximum support.  Part of the treatment was also surgical; I would transect the deep digital flexor tendons in both front legs.  If left intact, the pull of the  tendons would continue to rotate the coffin bones away from their normal position; a deep digital flexor tenotomy would allow us to reposition  the coffin bones to their normal position relative to the other bones of the lower leg.

These pictures show the trim; we lowered the heels to put the coffin bones back into normal position.  We also removed the anterior hoof wall and the dead laminar tissue overlying the coffin bone.  

Farrier Paul Magan initially applied what is called a heart bar egg bar shoe with a hospital plate.  The idea is to recruit the non painful areas of the foot to carry the load; the heart bar gives gentle support to the frog,  The rest of the space is filled with impression material, a soft rubbery material that gives support to the sole.  The shoe is drilled and tapped so we can bolt on a removable aluminum plate that allows us to keep an eye on the sole, while holding the impression material in place, and keeping out foreign material.  I don't have a picture of the original shoe; the shoe shown here was a reset done on March 3 with an open toe egg bar shoe with a hospital plate.  This final shoe was placed to relieve  pressure on the toe while giving good support to the heels and underside of the hoof.

After the shoe was in place we did the tendon transection.  The surgical site was blocked with local anesthetic and prepared for aseptic surgery.  A small incision was made over the tendon, it was dissected free of the other tissue in the region and transected as seen in the video.  After the transection the skin and subcutaneous tissue was sutured and and we applied a heavy support bandage.  The surgery was repeated on the other leg.

The pictures show what the foot looked like after the initial treatment.  The anterior hoof wall was removed and treated with a disinfectant, and the leg bandaged to give support to the surgical site.  The egg bar heart bar shoe is in place with the attached hospital plate.

On January 4 the shoes were reset, and more of the anterior hoof wall was removed to put the coffin bone in a more normal alignment.  At that time she was walking better, but still sore.   On March 3 Paul Magan applied an open toe heart bar to completely relieve the pressure on the front of the hoof; like before it was packed with impression material and had a hospital plate attached.  

The above radiographs show the position of the coffin bone on March 3, 2018.  The bone itself will not rotate back into normal position, but by removing the dead tissue under the hoof it may allow the new hoof growth to grow down into nearly normal position. 
Zoe is not completely sound and may never be completely sound, although it is too early to be able to say what the eventual outcome will be.  However as you can she is happy and doing reasonably well.  She has been a wonderful cooperative patient, and her owner has been a pleasure to work with.  This would not have been possible without a team approach.  A special thanks to Zoe's owner Mark Thorne, farrier Paul Magan of Moscow, and my veterinary technician Sandra Whittaker.  Zoe's gentle nature and perseverance through this entire episode has been an inspiration to all of us involved with her!

​There is a good reason to not jump on every bandwagon that comes along.  People in general are optimistic, and seek solutions to whatever problem is troubling them at the time.  I see it frequently in animal lovers.  We are notorious for falling for all types of therapies that will give us an "edge" over the competition; or help our old buddy with a chronic or life threatening problem.  It may be a training technique or gimmick,  drug, vitamin supplement, joint supplement, joint injection, or some type of miracle machine.  Many of these therapies are actually delivered by so called experts; chiropractors, acupuncturists, and sellers of various devices that are supposed to treat conditions that have never in the past been able to be treated successfully with conventional treatments.  They are often sold by or endorsed by celebrities, trainers, or others that inspire trust.  There are even licensed veterinarians that jump on these bandwagons and promote weird and unproven therapies.  There are treatments for founder, navicular syndrome, ringbone, infertility, kidney disease, ulcers, and even colic that neither I nor any other reputable veterinarian know anything about.  But if I ask Dr. Google, there it is in black and white on the internet complete with pages of testimonials on how wonderful said "therapy" is, and how "Old Paint" who was about to be put down is now running barrels like a 1D horse, or roping steers with the best of them.

The Placebo Affect  explains this phenomenon; the tendency of one who thinks they are being treated with a sham treatment will often get better, the effect of mind over matter.  This derives from several sources.  We want so badly for the treatment to work that we actually think it is working.  Or the problem is actually getting better; after all Mother Nature is a wonderful healer.  Any of us in the medical field who think we are actually healers are fooling ourselves.  The best we can do is remove the impediments to healing and allow the individual's system to heal itself.  That in a nutshell is the foundation of medical therapy.

When I began veterinary school back in the late 1960's many livestock owners  (and veterinarians) consulted the "Farmers Almanac" to check the phase of the moon prior to performing many procedures such as castrations, when to plant crops, when to turn the bulls out with the cows, etc..  I soon learned that if I practiced proper surgical technique it didn't matter where the moon was in its cycle.  And if I didn't place a proper ligature, they would bleed irregardless of where the moon was.

Sometime in the 17th Century people first started using the 'Scientific Method" to explore the natural world.  It has been refined over the years, and is the basis for how we (Veterinarians and Physicians) treat patients today; how we decide what treatments and pharmaceuticals actually work.  Researchers divide patients (animals or humans) into two groups randomly.   One group is given a treatment or drug, and the other is given a sham treatment or placebo.  Neither the patient nor the researcher knows who got the treatment and who got the non treatment.  The results are tabulated and analyzed statistically to see if there is a real difference between the two groups.  The difference between the two groups is calculated and expressed as a "P Value", a P Value of <.05 is generally accepted as a true difference, which means that there is less than a 5% chance that the difference was due to random chance.  

In medicine most of our treatments and drugs we use are based on research that has passed the P Value test.  Then after it is used clinically in real life situations we get a pretty good idea of what works and what doesn't.

Most of the "fad therapies" have not been tested scientifically.  There is no FDA oversight as long as no specific medical claims are made.   Anybody can say anything about a device, therapy, or any other product and advertise it as the next greatest thing in the universe as long as they avoid certain language.  It can't legally be advertised as diagnosing, treating, or curing any specific disease or condition.  But all types of implications can be made as long as certain words are avoided.  Most of them get by with making cleverly designed claims, and putting a disclaimer at the end saying "this PRODUCT is not intended to diagnose, cure or treat any disease or condition"  They then recommend that you consult a veterinarian or physician prior to using the device or product.  Of course, nobody does.

If these devices, treatments or therapies actually work there will be scientific evidence that they do in fact work.  If there is no scientific proof, they are ineffective.  It is not that hard to design a scientifically valid experiment to test.  If nothing is published it means that they are ineffective.  As a licensed veterinarian I can get into huge legal problems with the Board of Veterinary Medicine and even lose my license to practice by using or recommending unproven therapies outside the realm of generally accepted practice.

   The Facebook Post to the right is a perfect example.  This person is advertising a device which actually  does have some scientific backing in certain areas; it is a technology that has been around for many years and has benefited people and animals with certain conditions.  However she is making claims that are completely unbelievable.  I was recently sent a link to her Facebook page to evaluate what she was saying.   The page is full of amazing stories including claims that the coffin bone in a severely foundered horse was actually going back into the normal position.    
 When we take radiographs the software stamps an indelible date on the image to prevent fraud.  She apparently did not realize this.  The radiograph that she says was taken after treatment actually was taken in August of 2015 before the horse was foundered.  The other one she says was taken 2 weeks earlier was taken in January of 2018.    This does not mean the machine is no good, it just means that this lady is using totally unethical advertising practices.  I don't know if the machine is capable of healing or not; but I do know that at least one person selling it is totally unethical.  

This is but one example, and one that was easily caught.  Beware of advertisements of miracle therapies based solely on testimonials from users who have had good results.  The results may be made up and misinterpreted.  Remember the "Placebo Affect" and ask to see some peer reviewed scientific proof that it actually is effective. 

As a medical professional, my goal is to do the best I can for my clients.  Therefore I need scientific proof before I recommend a therapy.  If it really works, the scientific proof is readily available;  if all you can find are testimonials, then it is probably not an effective treatment.  The bottom line is "buyer beware". 

​At Rustebakke Veterinary Service we take great pride and care of our patients and their owners.  We strive to provide the highest quality of care for every animal that crosses our doorway.  Our clinic is certified by the American Animal Hospital Association (AAHA), the national standard of veterinary medicine.  We strongly feel these guidelines and recommendations are important for our own pets as well as our clients. 
For every anesthetic procedure, whether it is a spay, neuter, mass removal, or periodontal (dental cleaning) procedure, we recommend preanesthetic bloodwork to evaluate patient’s organ function and other risk factors.  
Also, IV catheter and IV fluids during the procedure is a standard we keep for most of our anesthetic procedures.  All canine neuters and spays and all canine and feline periodontal procedures will have an IV-catheter placed and IV fluids administered during the procedure.  All surgeries such as tumor removals or emergency procedures will have the same protocol.  We have found that we have less anesthetic events when we can help regulate body temperature and blood pressure with IV fluids.  We also have pets recovering from anesthesia better and able to go home with less complications.
We have an EKG monitoring system and trained veterinary support staff to monitor heart rate, blood pressure, and other anesthetic parameters throughout the procedure. 
In 2015 we purchased a digital radiology system able to perform intraoral radiographs for all our dental procedures.  AAHA also requires intraoral radiographs for all periodontal procedures.  We have found that being able to visualize roots and surrounding bone has made our decisions of whether to extract a tooth or not, easier.  Often time the visible tooth does not reflect the root system.  We can see abnormal root tips and shapes that will complicate the extraction process.  However, we can also make the decision to keep a tooth if the root system and bone is not diseased.
We highly recommend periodontal consults prior to a procedure so we can properly prepare you, the owner, for not only the cost of the procedure but the after care and further disease prevention.  We can also discuss the overall general health of each animal to make sure this anesthetic procedure will be beneficial.  Each pet and family are an individual and we hope to provide the best individual care that they require.
Human health care provides many of the same procedures and requirements.  The largest difference between your health care and your pets’ is that you can tell your doctor how you feel.  You also brush your teeth twice a day (at least I hope you do!) as routine preventative care.  Brushing your pet’s teeth twice daily is not feasible for majority of people, including us.  Incorporating home care such as brushing twice a week or dental treats/food will greatly reduce your dog or cat’s dental disease and number of anesthetic periodontal treatments. 
As veterinarians, we prefer preventative medicine and trying to reduce disease, rather than treating after the fact.  Treating disease is costlier for you and can be life limiting for your pet.  This includes vaccination protocols, periodontal health, spaying/neutering, and anesthetic procedures.    We love our pets and your pets healthy and happy!!
We hope you have a Merry Christmas Season and Happy New Year!
 
Dr. Jessica Bell, Dr. Cassidy Micahelis, and Dr. Christina Sparlin and our wonderful staff!

By Dr. Cassidy Michaelis

​This heifer was presented with a severe lameness in the left hind leg; examination revealed a draining tract at the coronet that extended into the coffin joint, the joint inside the hoof.  This is a  fairly common cause of lameness in cattle either from puncture wounds in the foot, or an extension from hoof rot.  The infection, if not treated, can easily extend into the coffin joint.  In the horse, a coffin joint infection is generally a death sentence as they are not amenable to treatment due to the inaccessability inside the hoof.  And horses do not have a spare.  Cattle are fortunate as they have two hooves (claws) on each leg; if one gets infected it can be removed, the healthy hoof can actually support the entire weight of the animal, and they can have a long and productive life in spite of a toe amputation.  The following video will show the procedure.  The animal is restrained in a chute, the foot is anesthetized with a local anesthetic, and a tourniquet is applied above the amputation site.  The hoof is then removed with a wire saw. You can see there is no pain to the animal during the procedure.  The stump is bandaged to control hemorrhage and keep it clean till healing can begin.  After a week or two depending on how it is doing, the bandage is removed and the animal is allowed to rejoin her pasture mates.   This hoof was removed on December 14, three weeks later she is completely healed and walking without a limp.

          The call came in about 1:30 PM on a cold winter day; a cow was having problems giving birth.  She was located in a corral in the Grand Ronde Canyon about 40 miles away; the road to the ranch was steep and snow packed; there was no way to haul her to the clinic.   My assistant Sandra and I drove in to give her a hand.  Chains on the 4 wheel drive truck were required!

          What I enjoy most about Veterinary Medicine is the challenge; we are often asked to do things that seem difficult or impossible.  However I have learned that difficult tasks are just a series of simple tasks put together in a logical sequence, one simple step at a time.

          This video illustrates how we make do in the field.  We have an uncooperative patient, and the operating room is primitive.  Human surgeons seldom need to do it this way.  We start out with a rope and halter with the cow tied to a fence as we don't want her going down in the squeeze chute.  She fought too much to get much done, however we were able to tell the calf was still alive, but it was in a position that was going to be very difficult to correct.  The chances for survival for the calf was better if we took her to surgery.

          We put her in the squeeze chute to shave and inject the incision site with local anesthetic; then moved her to an open sided chute with a head catch to do the surgery.  She had an epidural nerve block to control her straining and keep her from swishing her tail into the incision.   

          Although we do not have a sterile operating room available, we take great pains to be as sterile as possible; she was shaved and scrubbed with surgical soap and rinsed with alcohol; we use sterile instruments and sterile surgical gloves.   We make every attempt to avoid contamination.  

          The video illustrates how we do surgery in the field.  Cows are tough, and we seldom have complications.  We always tell the cow to take it easy for 2-3 months and avoid any heavy lifting; I have yet to have one follow my advice.  The rancher typically puts them in a smaller corral for a week or two, then they go back with the herd.  Skin sutures are typically  removed in 2-3 weeks, by the time the hair grows back there is no visible scar.

          As soon as the calf is out, the rancher (Dennis) clears the airway and makes sure it is doing OK.  After the surgery the cow is milked, and the calf is stomach tubed with fresh warm colostrum; they are  typically up and ready to nurse within an hour after birth.

          I have always admired these hard working men and women who ranch and raise cattle; it is not only a job, it is a way of life for them.  With the cold weather we have been having, Dennis and other ranching families are on duty 24 hours a day 7  days a week till the calves are on the ground.  Once the calves are dried off and get a belly full of warm milk, most do well in spite of the weather.  Many of the calves get to live in the warm house or in the warm  cab of a pickup for a few hours after birth till they get a warm meal and get dried off!  

          Thank you to my assistant Sandra Whittaker, who did double duty as surgical assistant and videographer; she tried to hand me stuff while remaining sterile with one hand and running the camera with the other; a master at multi tasking!  She also edited the video.   And thank you to Dennis Moss for allowing us to video his cow, and Bill Ruchert for his valuable assistance!